There are hundreds of millions of allergy sufferers and fewer than 300 specialists

(People's Daily health client Tan Qixin Lin Long)

Even though it is not the season of high allergies, the outpatient waiting room of the Department of Allergy (Allergic) Reactions of Peking Union Medical College Hospital is still full of people, and the patients waiting for treatment range from the elderly to children, covering all ages.

According to the latest statistics from the World Health Organization, allergic diseases have become the sixth largest disease in the world. According to a survey by the Allergology Branch of the Chinese Medical Association, the number of adults with allergic rhinitis alone in the mainland has reached 150 million. There are less than 300 specialists in allergies (allergies) nationwide, and no more than 3,000 doctors can diagnose and treat allergies.

Professor Yin Jia, Niu Hongchao.

Allergies are everywhere

"Allergies are too painful!" This is the most common sentence of feeling that patients say.

"The body's reaction mechanism is like it's malfunctioning." Lele (pseudonym), a 22-year-old patient with allergic rhinitis, described how he felt when he had an allergic rhinitis attack, and when the sky was clear and the wind was together, the snot and tears flowed uncontrollably.

Lele was diagnosed when she was 10 years old, and at first thought it was a cold, but later, "when she slept at night, it was as if there was a boulder pressed against her heart and could not breathe", and her parents took her to Peking Union Medical College Hospital for medical treatment, and was diagnosed with allergic rhinitis and allergic asthma.

According to serum-specific immunoglobulin E (commonly used in the diagnosis of allergies), the allergen that causes lele allergy symptoms is the pollen of artemisia plants that are scattered in the air of Beijing every summer and autumn.

"Pollen is one of the many important factors that induce allergic rhinitis; in the north, especially in the northwest, Shanxi, and Inner Mongolia, pollen concentrations are high, allergies are serious, and you can only go south, which is why the 'Great Migration' has become a helpless 'treatment' for pollen allergies." Wang Lianglu, executive deputy director of the Department of Allergy of Peking Union Medical College Hospital and chairman of the Allergology Branch of the Chinese Medical Association, said.

Wang Lianglu told the Health Times reporter that the overall prevalence of allergic diseases in China is estimated to be more than 20%, and allergic rhinitis is only one of the main "genres" of various allergic diseases. From the extremely rare red meat eating allergy to the common milk protein allergy; small to red and itchy skin, large to asthma, shock and even death, the causes and symptoms of allergies are diverse, and it is difficult to do one by one.

In the treatment process, "allergen preparations" are indispensable "sharp tools". At present, the consensus of allergists is that allergen-specific immunotherapy is the only effective way to prevent the natural process of allergic diseases, that is, through allergen screening and detection, find out which allergen caused the allergic reaction, in order to specifically treat the cause, and to find out the allergen, one of the most direct and effective methods is to use allergen preparations to do skin tests.

"After the doctor finds the allergen through the allergen preparation, and then injects it into the patient's body according to the dose from less to more, it can make the patient gradually develop tolerance to the allergen, generally after 1 to 2 years of desensitization treatment, it will take effect, and the overall course of treatment takes 3 to 5 years." Wang Lianglu explained to reporters.

Jia Yi (pseudonym), from Beijing, has an allergic rhinitis reaction that has been evident since the first and second grades of primary school, sneezing, nosebleeds, and itchy eyes in the spring and autumn. This caused her a lot of inconvenience. "When I go to school, I sit in the front row, because allergies will inexplicably shed tears, and the teacher will throw strange eyes." On important occasions, she needs to endure the puffiness of the face and the itching of the eyes and nose caused by allergic rhinitis to avoid "red when you rub it, and the more you rub it, the more itchy it is." Such nose sensitivity often occurs and requires temporary relief of pain by relying on anti-allergic drugs.

Yin Jia, president of the Allergy Physician Branch of the Chinese Medical Doctor Association and director of the Department of Allergy (Department) of Peking Union Medical College Hospital, told reporters that the allergy department of Peking Union Medical College Hospital began to look for allergens with Chinese characteristics from the beginning of its establishment. In the past 20 years, the department has successively established quality standards for raw materials and finished products of common allergen preparations and obtained the approval number of 9 kinds of allergen injection preparations for medical institutions, which can be transferred to hospitals across the country for clinical application. However, compared with the huge clinical demand, there are still too few allergy treatment preparations available.

There are too few allergy specialists

For allergy sufferer Jia Yi (pseudonym), the most troublesome thing is how to find professional treatment. "Over the years, I have been treated in many departments of major hospitals of traditional Chinese and Western medicine, but none of the doctors can cure the entire allergy." Jia Yi said.

"Allergies have become epidemics from the previous 'rare diseases', and in recent years, more and more patients have been received in outpatient clinics, and during the high incidence of allergies, the number of outpatients in our department can exceed 500 people a day." Wang Lianglu told reporters.

According to Wang Lianglu, in the early 1990s, when he first came to work in the Concordia Allergy Department, "allergies" were still a "fashionable" niche disease, and he saw about 20 to 30 patients a day. Today, with the control of the plus, he still has to receive about 20 patients in the morning, and the outpatient volume has increased by at least 50%.

According to the World Health Organization, the number of allergic diseases has grown rapidly, and in the past 30 years, the prevalence of allergic diseases has increased at least threefold, involving 22% of the world's population. In the mainland, the "China Allergic Rhinitis Diagnosis and Treatment Guidelines" shows that from 2005 to 2011, the prevalence of allergic rhinitis in adults alone in the mainland increased from 11.1% to 17.6%, and the number of patients increased by about 100 million in 6 years.

Yin Jia, who has been working for the prevention and treatment of allergic diseases in the mainland for more than 20 years, is also deeply aware that the mainland is experiencing the development process of the population with allergic diseases from rare to numerous. Based on the world's average incidence of allergic diseases, the number of patients with allergic diseases in China is in the hundreds of millions. However, it is difficult to ignore that there are relatively few allergy specialists in mainland China at present, and they cannot meet the growing clinical demand.

"Allergic diseases affect a wider range of people than we could have imagined. The connotation of allergens is very rich, and there are nearly 2,000 kinds of allergens recorded in the medical literature alone, of which more than 100 are common, which also means that it is necessary to professional and standardized diagnosis and treatment and establish a sound circulation database. However, at present, the team of specialist doctors in the national allergy department is only about 200 to 300 people, even if you add doctors who can engage in the diagnosis and treatment of allergic diseases in respiratory, pediatric, otorhinolaryngology and other departments, the number is only 3,000. Wang Lianglu was quite helpless.

Many patients who have been plagued by allergies for many years are still wandering in related departments such as otolaryngology, otorhinolaryngology, and pediatrics. Xiao Mo (pseudonym) from Guangxi is one of them. When Xiao Mo was in junior high school, she felt discomfort in her ears, and often had a runny nose and nosebleeds, and when she went to the school hospital, she was told that there was no corresponding medicine and needed to go to a big hospital to prescribe medicine. "Finally, accompanied by my parents, I went to the department of the local hospital for treatment, and the doctor described it as red nasal cavity, fragile capillaries, and diagnosed with mild allergic rhinitis, and the doctor only prescribed sprays that could make my nasal cavity unblock in a short period of time, and could not be cured for many years." Xiao Mo told reporters.

Song Qingyang (pseudonym), who lives in the northwest region, is also a patient suffering from allergic rhinitis. After being diagnosed with allergic rhinitis about three or four years ago, he needed to go to the hospital two to three times a year, but every year the allergy symptoms did not alleviate. In response to the severe allergic rhinitis reaction, Song Qingyang said: "I have been to many hospitals to see, and in general, it can only be alleviated and cannot be cured. He tried injections for desensitization and would go to the hospital to wash his nose when he had a severe allergic reaction. Now, the hormone drugs that were originally used are no longer effective, and the use of loratadine anti-sensitizers is currently required.

"The department of allergy is an emerging discipline in the mainland, as of now it is still in its infancy, hospitals in many areas have not set up a special allergy department, the local health system has not opened a special promotion series of allergies, and local colleagues engaged in allergies have to be promoted through the series of related disciplines such as ear, nose and throat science, respiratory diseases, pediatrics, and dermatology." Wang Lianglu said.

He mentioned that in this way, doctors who study allergies will inevitably encounter difficulties when facing the examination and promotion, not only the content of the examination is the content of entolaryngology, respiratory diseases, pediatrics, dermatology and other related disciplines, even if it passes the assessment, the doctor will compete for the promotion title of entolaryngology, respiratory diseases, pediatrics, skin science and other related disciplines.

Accelerate the improvement of the training system for allergy specialists

"At present, doctors who can provide diagnosis and treatment services for patients are scattered in the allergy (allergy) departments, pediatrics, internal medicine and other departments of various hospitals, and even in the allergy specialties integrated in some hospitals, doctors are not specialists who can independently engage in the diagnosis and treatment of allergic diseases. Allergic diseases are systemic diseases whose natural processes of development involve multiple organs and systems, and whose clinical characteristics require clinicians to recognize and address them as a whole. Therefore, the understanding and diagnosis and treatment of allergic diseases from the perspective of their respective specialties is very limited. Yin Jia said.

"Allergy symptoms are diverse, and allergy specialists do need to have a multidisciplinary background in internal medicine, pediatrics, ear, nose and throat, dermatology, etc., but to accurately diagnose and treat clinical allergic diseases, they must have allergy expertise." In this regard, Wang Lianglu suggested that we should speed up the improvement of the training system for allergy specialists, and at the same time encourage more qualified hospitals to set up allergy specialists individually.

Yin Jia revealed to reporters that in 2019, Peking Union Medical College Hospital took the lead in establishing a training and assessment system for allergy specialists in the country, selected doctors who had completed the medical training within three years, entered the 2 to 3 years of allergy specialty training program, and trained all allergic disease diagnosis and treatment skills for doctors who entered the special training. "I hope that in the future, we can promote this model of allergy specialist training in hospitals with conditions across the country as soon as possible, and at the same time, through active communication, coordinate relevant departments to accelerate the establishment of a national allergy (allergy) specialty assessment certification and management system."

"It is expected that this professional team of allergy disciplines can continue to grow strongly, base itself on the mainland, make disease diagnosis and treatment guidelines that meet the national conditions according to the data of the mainland, and carry out basic research on allergic diseases and research on domestic allergen diagnosis and treatment preparations." Yin Jia said.

(Health Times)